Optic Disk Drusen

Drusen are yellowish lobular bodies in the tissue of the optic disk that are usually bilateral (in 70% of all cases). Ophthalmoscopy can reveal superficial drusen but not drusen located deep in the scleral canal. In the presence of optic disk drusen, the disk appears slightly elevated with blurred margins and without an optic cup (Fig. 13.9). Abnormal morphologic signs such as hyper-emia and nerve fiber edema will not be present. However, bleeding in lines along the disk margin or subretinal peripapillary bleeding may occur in rare cases.

Fig. 13.8 Remnants of the hyaloid artery forming a veil-like epipapillary membrane overlying the surface of the optic disk are seen on nasal side.

Fig. 13.8 Remnants of the hyaloid artery forming a veil-like epipapillary membrane overlying the surface of the optic disk are seen on nasal side.

Fig. 13.9 The yellowish lobular deposits (drusen)

make the optic disk appear elevated with blurred margins and without an optic cup.

Fig. 13.9 The yellowish lobular deposits (drusen)

make the optic disk appear elevated with blurred margins and without an optic cup.

A small lamina cribrosa appears to be a factor in the etiology of the disorder. This impedes axonal plasma flow, which predisposes the patient to axonal degeneration. This in turn produces calcifications exterior to the axons (drusen). Retinal drusen are hyaline deposits in Bruch's membrane and are a completely unrelated process.

Drusen usually do not cause any loss of function. Deep drusen can cause compressive atrophy of nerve fibers with resulting subsequent visual field defects.

Optic disk drusen may be diagnosed on the basis of characteristic ultrasound findings of highly reflective papillary deposits. Fluorescein angiography findings of autofluorescence prior to dye injection are also characteristic. See Table 13.1 for differential diagnosis.

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